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Infección por SARS-CoV-2. Análisis descriptivo de una serie de casos seleccionada
SARS-CoV-2 infection. Descriptive analysis of a selected case series
C.L. Errando, C.S. Romero-García, M.J. Hernández-Cádiz, M.Á. Pallardó-López, J. Puig
Consorcio Hospital General Universitario de Valencia, Valencia, España
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al SARS-CoV-2&#46; Las caracter&#237;sticas de los pacientes&#44; las caracter&#237;sticas cl&#237;nicas&#44; la cronolog&#237;a del proceso diagn&#243;stico y los resultados se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Los pacientes 1 y 3&#44; y 2 y 4&#44; respectivamente&#44; eran pareja&#46; El paciente 6 era un amigo cercano del paciente 1&#44; con el que estuvo en contacto los d&#237;as previos al inicio de los s&#237;ntomas&#46; El curso cl&#237;nico y los hallazgos del paciente 5 se aportan debido a la especial gravedad y porque comparti&#243; una celebraci&#243;n con varias personas&#44; algunas de las cuales presentaban formas leves o moderadas de COVID-19&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0030" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> se muestran las caracter&#237;sticas evolutivas de los 4<span class="elsevierStyleHsp" style=""></span>pacientes que ingresaron en la UCI&#46; La <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a> muestra algunos de los procedimientos y el curso cl&#237;nico en la UCI y la <a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a> muestra una descripci&#243;n parcial de los procedimientos diagn&#243;sticos de imagen &#40;con detalles en las <a class="elsevierStyleCrossRefs" href="#fig0005">figuras 1-7</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="fig0030"></elsevierMultimedia><elsevierMultimedia ident="fig0035"></elsevierMultimedia><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Paciente 1</span><p id="par0035" class="elsevierStylePara elsevierViewall">Paciente var&#243;n de 64 a&#241;os con fiebre moderada durante 7 d&#237;as antes del ingreso&#44; seguido de los s&#237;ntomas resumidos en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; Se decidi&#243; ingreso en UCI tras el diagn&#243;stico de COVID-19 con neumon&#237;a y empeoramiento cl&#237;nico&#46; La intubaci&#243;n traqueal y la ventilaci&#243;n mec&#225;nica se iniciaron en el 2&#46;&#176; d&#237;a de ingreso en la UCI&#46; Los tratamientos espec&#237;ficos de COVID-19 y los protocolos locales de ese momento se resumen en la tabla 5 &#40;<a class="elsevierStyleCrossRef" href="#sec0060">anexo&#44; material adicional online</a>&#41;&#46; La mejor&#237;a cl&#237;nica y anal&#237;tica llev&#243; a la extubaci&#243;n 10<span class="elsevierStyleHsp" style=""></span>d&#237;as despu&#233;s&#46; Present&#243; episodios de agitaci&#243;n&#44; somnolencia&#44; desorientaci&#243;n de tiempo&#44; lugar y persona&#44; y habla incoherente en la UCI despu&#233;s de la extubaci&#243;n&#44; y en la sala de Neumolog&#237;a &#40;en la que permaneci&#243; en aislamiento respiratorio y de contacto&#44; acompa&#241;ado de su esposa&#44; que tambi&#233;n fue diagnosticada previamente de SARS-CoV-2&#44; paciente 3&#41;&#46; Una tomograf&#237;a computarizada tard&#237;a mostr&#243; tromboembolia pulmonar &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46; Fue dado de alta con enoxaparina&#46; La RT-PCR para SARS-CoV-2 fue positiva antes de su ingreso en el hospital y se negativiz&#243; 21 d&#237;as despu&#233;s&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Paciente 2</span><p id="par0040" class="elsevierStylePara elsevierViewall">Paciente var&#243;n de 63 a&#241;os que refiri&#243; fiebre de 5<span class="elsevierStyleHsp" style=""></span>d&#237;as de evoluci&#243;n y tos productiva&#46; Su curso cl&#237;nico se muestra en la <a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#46; Despu&#233;s de 7 d&#237;as en la unidad de Neumolog&#237;a&#44; requiri&#243; terapia en la UCI&#44; con intubaci&#243;n traqueal y ventilaci&#243;n mec&#225;nica&#46; La extubaci&#243;n fue posible 8 d&#237;as despu&#233;s&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Desarroll&#243; agitaci&#243;n&#44; desorientaci&#243;n que requiri&#243; infusi&#243;n de propofol en dosis bajas&#44; infusi&#243;n de dexmedetomidina y lorazepam&#44; seguido de risperidona&#46; En la sala de Neumolog&#237;a&#44; donde permaneci&#243; en aislamiento&#44; present&#243; delirio&#44; confusi&#243;n&#44; agitaci&#243;n moderada y euforia&#44; que mejoraron progresivamente&#46; Fue dado de alta a su domicilio &#40;donde viv&#237;a con su esposa&#44; paciente 4&#41; en autoaislamiento adicional durante 14 d&#237;as&#44; y con tratamiento con quetiapina&#46; La RT-PCR para SARS-CoV-2 fue positiva al ingreso y se volvi&#243; negativa 21 d&#237;as despu&#233;s&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Pacientes 3 y 4</span><p id="par0050" class="elsevierStylePara elsevierViewall">Estas pacientes estuvieron conviviendo con sus respectivas parejas &#40;pacientes 1 y 2&#41; durante al menos 7 d&#237;as mientras que ambos ten&#237;an s&#237;ntomas de COVID-19 y antes de la hospitalizaci&#243;n&#46; Sus s&#237;ntomas fueron anosmia y disgeusia&#47;ageusia&#44; duraron m&#225;s de 10<span class="elsevierStyleHsp" style=""></span>d&#237;as&#46; La paciente 3 refiri&#243; adem&#225;s fiebre leve durante 3 d&#237;as&#46; Por otra parte&#44; estuvieron en aislamiento domiciliario durante 2<span class="elsevierStyleHsp" style=""></span>semanas despu&#233;s del diagn&#243;stico&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Paciente 5</span><p id="par0055" class="elsevierStylePara elsevierViewall">Paciente var&#243;n aquejado de fiebre &#40;37&#44;9<span class="elsevierStyleHsp" style=""></span>&#176;C&#41;&#44; taquipnea &#40;40<span class="elsevierStyleHsp" style=""></span>rpm&#41;&#44; cianosis y SaO2 77&#37; respirando aire ambiente&#59; presi&#243;n arterial 140&#47;70<span class="elsevierStyleHsp" style=""></span>mmHg y frecuencia card&#237;aca 110 latidos por minuto&#46; Se diagnostic&#243; neumon&#237;a intersticial bilateral &#40;<a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a>&#41;&#46; Al sufrir deterioro neurol&#243;gico ingres&#243; en la UCI&#44; donde se inici&#243; ventilaci&#243;n mec&#225;nica tras intubaci&#243;n traqueal&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">El tratamiento se realiz&#243; seg&#250;n protocolo &#40;<a class="elsevierStyleCrossRef" href="#sec0060">anexo&#44; tabla 5&#44; material adicional online</a>&#41;&#46; Se realiz&#243; traqueotom&#237;a precoz&#46; Los par&#225;metros anal&#237;ticos mostraron niveles elevados de d&#237;mero D&#44; ferritina y LDH&#44; que se mantuvieron elevados en el tiempo &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; La radiolog&#237;a de t&#243;rax mostr&#243; deterioro &#40;<a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a>&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Se inici&#243; tratamiento con &#243;xido n&#237;trico inhalado por hipoxemia refractaria&#46; Debido al proceso inflamatorio persistente&#44; se introdujo anakinra &#40;antagonista del receptor de IL-1&#41;&#46; A pesar de esto&#44; la oxigenaci&#243;n no mejor&#243;&#46; Le sigui&#243; infecci&#243;n por <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>&#44; estreptococos y coinfecciones f&#250;ngicas&#44; tratadas seg&#250;n antibiograma y protocolo local&#46; Finalmente&#44; desarroll&#243; inestabilidad hemodin&#225;mica tratada con dosis bajas de noradrenalina y dobutamina&#46; Se a&#241;adi&#243; anticoagulaci&#243;n con heparina de bajo peso molecular &#40;HBPM&#41; a dosis completa y posteriormente fondaparinux&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Complicaciones desarrolladas a partir de la cuarta semana en la UCI&#58; neumot&#243;rax izquierdo &#40;<a class="elsevierStyleCrossRef" href="#fig0015">figura 3</a>&#41;&#44; insuficiencia renal&#44; aumento de marcadores de lesi&#243;n mioc&#225;rdica &#40;con ecocardiograf&#237;as normales&#41;&#44; neumot&#243;rax derecho &#40;que precis&#243; toracotom&#237;a por hemot&#243;rax&#44; <a class="elsevierStyleCrossRef" href="#fig0020">figura 4</a>&#41;&#44; hemocultivos positivos a <span class="elsevierStyleItalic">Candida auris</span> e insuficiencia hep&#225;tica&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">En los &#250;ltimos d&#237;as antes de fallecer&#44; se introdujo ruxolitinib &#40;inhibidor de las cinasas JAK1 y JAK2&#41;&#44; con indicaci&#243;n de uso compasivo&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">La RT-PCR para el SARS-CoV-2 dio positivo en la primera admisi&#243;n y se volvi&#243; negativa 25 d&#237;as despu&#233;s&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Paciente 6</span><p id="par0085" class="elsevierStylePara elsevierViewall">Var&#243;n de 74 a&#241;os ingresado en Urgencias por fiebre de 39<span class="elsevierStyleHsp" style=""></span>&#176;C&#44; tos y mareos&#46; Hab&#237;a asistido a una reuni&#243;n con amigos que hab&#237;an sido diagnosticados de SARS-CoV-2 mediante RT-PCR varios d&#237;as despu&#233;s &#40;incluida su esposa&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">La SaO2 fue del 84&#37; respirando aire ambiente&#44; mejorando al 99&#37; con mascarilla&#44; pero ten&#237;a hipotensi&#243;n arterial &#40;80&#47;50<span class="elsevierStyleHsp" style=""></span>mmHg&#44; 65 latidos por minuto&#41;&#44; taquipnea y cianosis&#46; Se indic&#243; ingreso en la UCI e intubaci&#243;n traqueal 6 d&#237;as despu&#233;s&#46; Se inici&#243; la infusi&#243;n de noradrenalina a dosis bajas&#46; Se diagnostic&#243; neumon&#237;a at&#237;pica bilateral &#40;<a class="elsevierStyleCrossRef" href="#fig0025">figura 5</a>&#41;&#46; El tratamiento fue protocolizado &#40;<a class="elsevierStyleCrossRef" href="#sec0060">tabla 5&#44; material adicional online</a>&#41;&#46; La administraci&#243;n profil&#225;ctica de enoxaparina fue seguida de dosis terap&#233;uticas &#40;luego cambiadas a fondaparinux&#41; debido a trastornos de los par&#225;metros de coagulaci&#243;n&#46; Se realiz&#243; traqueotom&#237;a el d&#237;a 17 de estancia en la UCI&#46; Una tomograf&#237;a computarizada mostr&#243; consolidaciones bilaterales y derrame pleural &#40;<a class="elsevierStyleCrossRef" href="#fig0030">figura 6 a y b</a>&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">En los &#250;ltimos d&#237;as present&#243; polineuropat&#237;a&#44; miopat&#237;a e insuficiencia renal&#46; Varias ecocardiograf&#237;as transtor&#225;cicas y transesof&#225;gica no mostraron alteraciones&#46; La radiolog&#237;a de t&#243;rax mostr&#243; permiti&#243; sospechar coinfecci&#243;n &#40;<a class="elsevierStyleCrossRef" href="#fig0035">figura 7</a>&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Aparecieron sucesivamente bacteriemias debidas a coinfecciones o colonizaci&#243;n &#40;<span class="elsevierStyleItalic">Staphylococcus aureus</span> sensible a meticilina&#44; <span class="elsevierStyleItalic">Acinetobacter baumanii</span>&#44; <span class="elsevierStyleItalic">Enterobacter cloacae</span>&#44; <span class="elsevierStyleItalic">Enterococcus faecium</span> y <span class="elsevierStyleItalic">Candida auris</span>&#41; que fueron tratadas seg&#250;n antibiograma&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Un intento de destete de la ventilaci&#243;n mec&#225;nica no tuvo &#233;xito&#46; El fallo multiorg&#225;nico condujo al fallecimiento a los 44 d&#237;as de ingreso en la UCI&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discusi&#243;n</span><p id="par0110" class="elsevierStylePara elsevierViewall">En nuestro hospital &#40;<a class="elsevierStyleCrossRef" href="#sec0060">anexo&#44; tablas 6 y 7 material adicional online</a>&#41;&#44; 1&#46;226 pacientes fueron diagnosticados de infecci&#243;n con SARS-CoV-2&#44; 371 &#40;30&#44;26&#37;&#41; fueron hospitalizados y 66 &#40;5&#44;38&#37;&#44; 43 varones&#41; ingresaron en la UCI&#46; La mortalidad en la UCI fue del 44&#37; &#40;29 pacientes fallecieron&#41; en esa primera oleada de la pandemia&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">En este art&#237;culo describimos los hallazgos cl&#237;nicos&#44; de laboratorio y radiol&#243;gicos en 6 pacientes seleccionados diagnosticados de COVID-19 en un hospital de tercer nivel del sistema p&#250;blico de salud en Valencia&#44; Espa&#241;a&#46; Los pacientes ingresaron durante la 2&#46;&#170; y la 3&#170; semanas de la pandemia en este pa&#237;s&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Se desconocen las causas de la diferente evoluci&#243;n cl&#237;nica de los pacientes infectados simult&#225;nea o posteriormente a los casos &#237;ndice&#46; El per&#237;odo medio de incubaci&#243;n antes del inicio de los s&#237;ntomas es de aproximadamente 4 a 5 d&#237;as y casi todos los pacientes sintom&#225;ticos desarrollan s&#237;ntomas en 11&#44;5 d&#237;as<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">2</span></a>&#46; Se se&#241;alan la carga viral&#44; las caracter&#237;sticas propias del paciente &#40;edad avanzada&#44; varones&#44; factores gen&#233;ticos&#41; y las enfermedades &#40;hipertensi&#243;n arterial&#44; diabetes&#44; etc&#46;&#41;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">En nuestros casos&#44; al ingreso&#44; los s&#237;ntomas fueron similares ya fueran los pacientes leves o graves&#44; pero los &#250;ltimos empeoraron en los 5<span class="elsevierStyleHsp" style=""></span>d&#237;as siguientes&#46; Esto coincide con otras publicaciones<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Se ha comunicado a partir de contactos cercanos de pacientes con COVID-19 confirmados en Wuhan<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a> que los asintom&#225;ticos&#44; en comparaci&#243;n con los sintom&#225;ticos&#44; eran m&#225;s j&#243;venes&#44; mujeres en mayor proporci&#243;n&#44; mostraban cifras m&#225;s altas de linfocitos T CD4&#43; en la recuperaci&#243;n&#44; una mejor&#237;a radiol&#243;gica m&#225;s r&#225;pida y menor duraci&#243;n de la diseminaci&#243;n viral &#40;muestras a partir de hisopos nasofar&#237;ngeos&#59; duraci&#243;n media &#91;rango intercuart&#237;lico&#93;&#44; 8 &#91;3-12&#93; d&#237;as frente a 19 &#91;16-24&#93; d&#237;as&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; A partir de estos resultados&#44; se puede sugerir que los pacientes con infecciones m&#225;s leves podr&#237;an tener menos alteraciones del sistema inmunol&#243;gico&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Cabe destacar que los 4<span class="elsevierStyleHsp" style=""></span>pacientes gravemente afectados hab&#237;an sido tratados con antihipertensivos y 3<span class="elsevierStyleHsp" style=""></span>de ellos con antagonistas del receptor de angiotensina-<span class="elsevierStyleSmallCaps">ii</span> o inhibidores de la enzima conversora de angiotensina&#46; Existe controversia sobre el curso cl&#237;nico de la enfermedad en pacientes que fueron tratados con ambos f&#225;rmacos&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Adem&#225;s&#44; varios par&#225;metros anal&#237;ticos se han relacionado con peores resultados&#44; incluida una mayor mortalidad<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">4&#44;6</span></a>&#46; Llama la atenci&#243;n que los pacientes que desarrollaron trastornos graves de la coagulaci&#243;n&#44; principalmente en la circulaci&#243;n pulmonar &#40;pacientes 1 y 5&#41;&#44; mostraron los resultados m&#225;s elevados de d&#237;mero D &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#44; hecho que ha sido notificado<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a>&#46; Recientemente&#44; se ha evidenciado que se trataba de un estado de hipercoagulabilidad en la mayor&#237;a de los pacientes y en m&#225;s del 60&#37; exist&#237;a evidencia cl&#237;nica de eventos tromb&#243;ticos&#44; especialmente en los enfermos cr&#237;ticos&#46; Esta circunstancia puede explicar las embolias pulmonares&#44; que se suman a la vasculitis pulmonar y la endotelialitis&#46; Los trombos de la arteria pulmonar del paciente 1 fueron diagnosticados con retraso relativo &#40;cercano al alta hospitalaria&#41; debido a hipoxemia persistente&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Conseguimos escasas determinaciones de laboratorio de IL-6&#44; pero este marcador inflamatorio tambi&#233;n pareci&#243; aumentado&#46; Tambi&#233;n se ha descrito como un marcador independiente de mortalidad intrahospitalaria<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Por tanto&#44; las concentraciones de d&#237;mero D e IL-6 al ingreso parecieron predictores de mortalidad&#46; En nuestros pacientes&#44; ambas&#44; adem&#225;s de la ferritina&#44; se incrementaron desde los primeros estadios de la enfermedad como expresi&#243;n del s&#237;ndrome hiperinflamatorio que se ha sugerido como causa de afectaci&#243;n multiorg&#225;nica en la COVID-19&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">La linfopenia es otro hallazgo repetido en pacientes con COVID-19<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">2</span></a> y tambi&#233;n puede ser de valor pron&#243;stico&#46; Recientemente&#44; ha sido revisado el papel de las c&#233;lulas del sistema inmunol&#243;gico en la inmunopatogenicidad del da&#241;o pulmonar y la hiperinflamaci&#243;n general<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Ninguno de nuestros pacientes desarroll&#243; un deterioro org&#225;nico relevante en los primeros d&#237;as&#47;semanas salvo afectaci&#243;n pulmonar y signos de inflamaci&#243;n generalizada &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46; Respecto a esto&#44; la ferritina&#44; como marcador &#40;o mediador&#41; de la inflamaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a>&#44; se increment&#243; y se mantuvo elevada en los casos de mayor estancia en UCI &#40;pacientes 2&#44; 5 y 6&#41; y evoluci&#243;n m&#225;s grave &#40;pacientes 5 y 6&#41;&#46; A pesar del aumento de troponina <span class="elsevierStyleSmallCaps">i</span> ultrasensible&#44; no se encontraron hallazgos de cardiopat&#237;a en exploraciones de imagen repetidas en todos los pacientes durante su estancia en la UCI&#46; En nuestros pacientes&#44; contrariamente a algunas publicaciones&#44; solo se observaron algunos cambios en el electrocardiograma&#44; como bradicardia&#44; discreta prolongaci&#243;n de QT o QTc&#44; y fibrilaci&#243;n auricular en algunos casos&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Los pacientes con peor evoluci&#243;n presentaban varias coinfecciones&#44; poco frecuentes en el momento de presentaci&#243;n&#44; por lo que las alteraciones de los par&#225;metros anal&#237;ticos tard&#237;os coincid&#237;an con un aumento de lactato&#44; procalcitonina&#44; prote&#237;na C reactiva&#44; etc&#46; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#44; similar a un s&#237;ndrome de dificultad respiratoria aguda t&#237;pico&#44; agravado por coinfecciones concurrentes&#46; Se ha publicado que las infecciones virales sist&#233;micas suelen ir acompa&#241;adas o seguidas de inmediato de infecciones bacterianas y f&#250;ngicas y que estas influyen en el resultado final<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a>&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Adem&#225;s de la anosmia y la disgeusia&#44; recientemente se ha revisado el tema de la afectaci&#243;n del sistema nervioso central &#40;SNC&#41;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a>&#46; Nos gustar&#237;a rese&#241;ar las alteraciones neurol&#243;gicas que hemos observado constantemente en estos pacientes&#46; Aunque no est&#225; especialmente definido en los primeros grandes estudios de China&#44; EE&#46; UU&#46; e Italia&#44; desde que ingresaron los primeros casos en nuestro hospital y en la UCI&#44; los pacientes presentaban problemas neurol&#243;gicos y psiqui&#225;tricos&#46; Los pacientes en la UCI presentaban confusi&#243;n&#44; mareos&#44; somnolencia y aparec&#237;an desorientados y bradips&#237;quicos al ingreso &#40;con SaO2 normal a moderadamente baja y normocapnia&#41;&#44; y los mismos s&#237;ntomas m&#225;s agitaci&#243;n&#44; delirio&#44; euforia&#44; confusi&#243;n&#44; etc&#46; cuando ya se deten&#237;a la sedaci&#243;n y estaban extubados&#44; as&#237; como tambi&#233;n en la sala de hospitalizaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a>&#46; La afectaci&#243;n del SNC podr&#237;a explicarse por hipoxia o efectos secundarios de f&#225;rmacos &#40;sedantes&#44; relajantes musculares&#41;&#44; pero algunos pacientes tambi&#233;n presentaron estos s&#237;ntomas a pesar de una corta estancia en la UCI&#46; Podemos especular sobre varios mecanismos de afectaci&#243;n del SNC porque otros coronavirus tambi&#233;n son neurotr&#243;picos y debido a que inicialmente se comunic&#243; escasamente la afectaci&#243;n neurol&#243;gica&#44; a pesar de que la incidencia era entre el 36&#44;4<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a> y el 67&#37;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a>&#46; Sin embargo&#44; a&#250;n se desconoce si esto es una consecuencia de la invasi&#243;n viral o la reacci&#243;n inflamatoria general&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">La rotura de la integridad de la barrera hematoencef&#225;lica&#44; un paso te&#243;rico esencial para el ataque al SNC&#44; es producida por varios mecanismos y factores que incluyen&#44; entre otras&#44; la edad avanzada&#44; la inflamaci&#243;n y las viriasis<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a>&#46; Adem&#225;s&#44; podr&#237;amos teorizar que puede prevalecer una alteraci&#243;n funcional y no es necesaria la invasi&#243;n viral directa&#44; por ejemplo&#44; mediante alteraci&#243;n de la v&#237;a antiinflamatoria colin&#233;rgica<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a>&#46; Adem&#225;s&#44; la neuroinvasi&#243;n que afecta a algunos n&#250;cleos del SNC podr&#237;a explicar&#44; al menos en parte&#44; el origen de la insuficiencia respiratoria de algunos pacientes con COVID-19<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a> y podr&#237;a tener implicaciones terap&#233;uticas&#46; Queda por dilucidar si este da&#241;o persiste en el tiempo&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Los pacientes cr&#237;ticos fueron tratados seg&#250;n los protocolos institucionales&#46; Sin embargo&#44; estos iban cambiando d&#237;a a d&#237;a &#40;seg&#250;n recomendaciones del Ministerio de Sanidad y de la administraci&#243;n local&#41;&#44; por lo que el momento preciso en el que se inclu&#237;an algunos f&#225;rmacos no era el mismo para todos los pacientes&#46; Por ejemplo&#44; los antiinflamatorios se iniciaron m&#225;s de una semana despu&#233;s de la aparici&#243;n de los s&#237;ntomas en todos los casos&#44; dependiendo de la respuesta cl&#237;nica y los hallazgos anal&#237;ticos&#46; Adem&#225;s&#44; hemos tenido escasez de f&#225;rmacos&#44; como anakinra o sedantes&#46; Esto impidi&#243;&#44; en parte&#44; un enfoque por etapas &#40;ventana terap&#233;utica&#41;&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Esta serie de casos tiene varias limitaciones&#46; El n&#250;mero de casos es escaso&#44; pero nuestro objetivo es mostrar las caracter&#237;sticas de casos t&#237;picos de la enfermedad seleccionados&#46; Por supuesto&#44; no se busc&#243; una relaci&#243;n causal&#44; pero la informaci&#243;n descriptiva podr&#237;a ser interesante para el lector&#44; porque esta es la forma en que la mayor&#237;a de los pacientes se presentaron durante la pandemia&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; presentamos las diferentes v&#237;as evolutivas y los resultados de 6<span class="elsevierStyleHsp" style=""></span>pacientes diagnosticados de COVID-19 con estrecha relaci&#243;n entre ellos&#44; y discutimos sobre los hallazgos t&#237;picos&#44; las caracter&#237;sticas cl&#237;nicas&#44; de laboratorio y radiol&#243;gicas&#44; y la fisiopatolog&#237;a de la enfermedad&#44; adem&#225;s de los ampliamente descritos del sistema respiratorio&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflicto de intereses</span><p id="par0195" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La COVID-19 fue declarada pandemia en marzo del 2020&#46; Han sido comunicados los hallazgos cl&#237;nicos&#44; anal&#237;ticos y radiol&#243;gicos&#46; Sin embargo&#44; la diversa evoluci&#243;n de pacientes del mismo brote local lo ha sido escasamente&#46; Comunicamos en este trabajo 6 casos seleccionados de tal evoluci&#243;n&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Casos cl&#237;nicos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se expone la evoluci&#243;n cl&#237;nica&#44; radiol&#243;gica y anal&#237;tica de 6 pacientes&#46; Estos fueron seleccionados ya que fueron epidemiol&#243;gicamente contactos estrechos y mostraron una evoluci&#243;n cl&#237;nica particularmente diferente&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">El curso cl&#237;nico al inicio de la infecci&#243;n &#40;primera semana&#41; fue similar entre los pacientes&#46; En relaci&#243;n con la evoluci&#243;n cl&#237;nica&#44; un curso moderado a severo se relacion&#243; evolutivamente con marcadores elevados de inflamaci&#243;n &#40;d&#237;mero D&#44; IL-6&#44; ferritina&#44; linfopenia&#44; etc&#46;&#41;&#46; Fueron observadas alteraciones pulmonares t&#237;picas&#44; pero fueron comunes tambi&#233;n hallazgos neurol&#243;gicos y neuropsiqui&#225;tricos&#46; En la evoluci&#243;n 2<span class="elsevierStyleHsp" style=""></span>pacientes mostraron s&#237;ntomas moderados&#44; pero los 2<span class="elsevierStyleHsp" style=""></span>m&#225;s gravemente afectados murieron&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Est&#225; por elucidar las diferentes v&#237;as evolutivas y resultados finales de los pacientes con COVID-19&#46; En nuestros 6 pacientes del mismo brote local&#44; las caracter&#237;sticas cl&#237;nicas&#44; de laboratorio y radiol&#243;gicas fueron diferentes&#46; Discutimos aspectos de la fisiopatolog&#237;a de la enfermedad distintos de los ampliamente descritos del sistema respiratorio&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">COVID-19 was declared pandemic by March 2020&#46; Clinical&#44; analytical&#44; and radiological findings have been reported&#46; Detailed different evolution of patients of the same local outbreak has been scarcely reported&#46; We report 6 selected cases of such an evolution&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Clinical cases</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The clinical&#44; radiological&#44; analytical evolution of 6<span class="elsevierStyleHsp" style=""></span>patients is reported&#46; Patients were selected as it were epidemiological close contacts&#44; and showed particular different clinical evolution&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The clinical course at the start of infection &#40;first week&#41; was similar among patients&#46; In relationship with clinical evolution&#44; middle to severe course were related with inflammation markers levels evolution &#40;D-dimer&#44; IL-6&#44; ferritin&#44; lymphocytes count&#44; etc&#46;&#41;&#46; Specially lung alterations were observed&#44; but neurological&#47;neuropsychiatric findings are still common&#46; In evolution&#44; 2<span class="elsevierStyleHsp" style=""></span>patients showed middle symptoms&#44; but the 2<span class="elsevierStyleHsp" style=""></span>most severely affected died&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">It remains to be elucidated the different evolutive pathways and outcomes of COVD-19&#46; In our 6<span class="elsevierStyleHsp" style=""></span>patients of the same local outbreak&#44; clinical&#44; laboratory and radiological features were different&#46; We discuss some aspects of the pathophysiology of the disease&#44; other than the widely described of the respiratory system&#46;</p></span>"
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          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Los pacientes 1 y 3 y los pacientes 2 y 4 eran pareja&#44; los pacientes 5 y 6 fallecieron en la UCI&#46;</p><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">NA&#58; no aplicable&#59; HBPM&#58; heparina de bajo peso molecular&#59; RT-PCR&#58; transcriptasa inversa-reacci&#243;n en cadena de la polimerasa&#59; SDPT&#58; s&#237;ndrome de distr&#233;s postraum&#225;tico&#46;</p>"
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Primer s&#237;ntoma hasta RT-PCR&#8211;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">T&#46; desde primer s&#237;ntoma hasta ingreso en hospital&#47;UCI<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Estancia en UCI<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Estancia en hospital<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Resultado final f&#237;sico&#47;psicol&#243;gico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Paciente 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64 a&#241;os&#44; var&#243;n&#44; 82<span class="elsevierStyleHsp" style=""></span>kg&#44; 176<span class="elsevierStyleHsp" style=""></span>cm&#44; hipertensi&#243;n arterial&#44; dislipidemia&#44; amlodipino&#44; telmisart&#225;n&#44; omeprazol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fiebre&#44; malestar&#44; dolores musculares&#44; cefalea&#44; diarrea&#44; disnea&#44; v&#243;mitos&#44; astenia&#44; mareos&#44; v&#233;rtigo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#47;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Microtrombos en arterias pulmonares que precisaron dosis terap&#233;uticas de HBPM&#44; p&#233;rdida de peso&#44; fatiga&#47;sensaci&#243;n de estar muy mal&#44; SDPT<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Paciente 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63 a&#241;os&#44; var&#243;n&#44; 65<span class="elsevierStyleHsp" style=""></span>kg&#44; 172<span class="elsevierStyleHsp" style=""></span>cm&#44; hipertensi&#243;n arterial&#44; dislipidemia&#44; asma&#44; amlodipino&#44; atorvastatina&#44; prednisona&#44; budesonida&#44; formoterol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fiebre&#44; tos seca&#44; astenia&#44; fatiga&#44; disnea&#44; palpitaciones&#44; mareos&#44; v&#233;rtigo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#47;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P&#233;rdida de peso&#44; palpitaciones&#44; fatiga&#44; insomnio&#47;sensaci&#243;n de estar muy mal&#44; SDPT<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>Quetiapina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Paciente 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61 a&#241;os&#44; mujer&#44; 65<span class="elsevierStyleHsp" style=""></span>kg&#44; 158<span class="elsevierStyleHsp" style=""></span>cm&#44; osteoporosis&#44; vitamina D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fiebre&#44; malestar&#44; cefalea&#44; diarrea&#44; n&#225;useas&#44; mareo discreto &#40;todos de corta duraci&#243;n&#41;&#44; anosmia&#44; ageusia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sin secuelas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Paciente 4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57 a&#241;os&#44; mujer&#44; 70<span class="elsevierStyleHsp" style=""></span>kg&#44; 160<span class="elsevierStyleHsp" style=""></span>cm&#44; fumadora moderada&#44; hipotiroidismo&#44; levotiroxina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fiebre&#44; anosmia&#44; ageusia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sin secuelas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Paciente 5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63 a&#241;os&#44; var&#243;n&#44; 90<span class="elsevierStyleHsp" style=""></span>kg&#44; 160<span class="elsevierStyleHsp" style=""></span>cm&#44; hipertensi&#243;n arterial&#44; losart&#225;n&#44; atorvastatina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tos&#44; fiebre&#44; malestar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#47;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Traqueostom&#237;a&#44; neumot&#243;rax bilateral&#44; toracotom&#237;a&#44; fallecimiento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Paciente 6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74 a&#241;os&#44; var&#243;n&#44; hipertensi&#243;n arterial&#44; tromboembolia pulmonar&#44; dislipidemia&#44; candesart&#225;n&#44; hidroclorotiazida&#44; alopurinol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tos&#44; fiebre&#44; mareos&#44; mialgias&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#47;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Traqueostom&#237;a&#44; fallecimiento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">V&#233;ase el texto para explicaciones adicionales&#46;</p>"
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            2 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Permaneci&#243; positivo hasta el deceso&#46;</p>"
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        "descripcion" => array:1 [
          "es" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas demogr&#225;ficas&#44; s&#237;ntomas y detecci&#243;n de la RT-PCR frente a SARS-CoV-2 y resultado final</p>"
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          "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Los pacientes 3 y 4 no ingresaron en el hospital y en ellos no se realiz&#243; an&#225;lisis de sangre ni radiolog&#237;a&#46;</p><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Los datos mostrados son al ingreso en el hospital&#44; peor resultado &#40;nadir&#41; y tendencia general del dato &#40;si esta se manten&#237;a m&#225;s de 5 d&#237;as consecutivos&#41;&#46; INR&#58; cociente internacional normalizado &#40;international normalized ratio&#41;&#46; Na&#58; sodio&#46; K&#58; potasio&#46; AST&#58; aspartatot aminotransferasa&#46; ALT&#58; alaninaaminotransferasa&#46; GGT&#58; Gamma-glutariltranspeptidasa&#46; LDH&#58; lactatodeshidrogenasa&#46; Troponina I US&#58; troponina I ultrasensible&#46;</p><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">&#61;&#58; en rango normal&#59; &#62;&#58; predominantemente mayor que el rango normal&#59; &#60;&#58; predominantemente inferior al rango normal&#46;</p>"
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Fechas de alta UCI &#40;alta del hospital&#41;&#47;fallecimiento<span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Paciente 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#47;04&#47;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#47;03&#47;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">169&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">274&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">07&#47;04&#47;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">459&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#47;04&#47;20 &#40;29&#47;04&#47;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Paciente 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#47;03&#47;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#47;03&#47;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">368&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">01&#47;04&#47;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">442&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">08&#47;04&#47;20 &#40;20&#47;04&#47;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Paciente 5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#47;03&#47;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">132&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#47;03&#47;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">328&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#47;05&#47;20<span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Paciente 6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#47;03&#47;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#47;03&#47;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">260&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#47;05&#47;20<span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "es" => "<p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">Detalles de estancia en UCI</p>"
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          "leyenda" => "<p id="spar0130" class="elsevierStyleSimplePara elsevierViewall">ECG&#58; hallazgos electrocardiogr&#225;ficos&#59; ND&#58; no disponible&#59; QRS&#58; tipo de complejo QRS&#59; QT y QTc&#58; duraci&#243;n del intervalo QT &#40;rango normal 400-440<span class="elsevierStyleHsp" style=""></span>ms&#41;&#59; Rx 1&#58; radiograf&#237;a de t&#243;rax al ingreso en UCI&#59; Rx 2&#58; peores hallazgos en la radiograf&#237;a de t&#243;rax &#40;ambos con fecha de realizaci&#243;n&#41;&#44; TC&#58; tomograf&#237;a computarizada&#59; US&#58; exploraci&#243;n pulmonar con ultrasonidos&#46;</p>"
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ECG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Rx 1 &#40;fecha&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Rx 2 &#40;fecha&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Otras exploraciones de imagen&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Paciente 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ritmo sinusal&#44; 82 lpm&#44; QRS estrecho&#44; QTc 491<span class="elsevierStyleHsp" style=""></span>ms&#46; Sin cambios en la estancia en UCI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Opacidades parenquimatosas bilaterales &#40;25&#47;03&#47;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Opacidades parenquimatosas en ambos pulmones&#44; derrame pleural bilateral &#40;30&#47;03&#47;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TC&#58; tromboembolismo pulmonar en el l&#243;bulo superior derecho y varias arterias segmentarias&#44; as&#237; como de arterias segmentarias del l&#243;bulo superior izquierdo&#59; opacificaciones difusas bilaterales &#8220;en vidrio deslustrado&#8221; &#40;16&#47;04&#47;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Paciente 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ritmo sinusal&#44; 85 lpm&#44; QRS estrecho&#44; QT 393<span class="elsevierStyleHsp" style=""></span>ms&#46; Sin cambios en la estancia en UCI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Opacidades bilaterales &#40;23&#47;03&#47;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No opacidades &#40;03&#47;04&#47;20&#41;Atelectasias laminares &#40;17&#47;04&#47;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Paciente 5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ritmo sinusal&#44; 90 lpm&#44; QRS estrecho&#44; QT 500 ms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Opacificaciones reticulares intersticiales en l&#243;bulo medio &#40;25&#47;03&#47;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Patr&#243;n reticular intersticial&#44; opacidades subpleurales bilaterales&#44; discreto patr&#243;n alveolointersticial &#40;10&#47;04&#47;20&#41;Neumot&#243;rax bilateral &#40;no simult&#225;neo&#41; y enfisema subcut&#225;neo &#40;22&#47;04&#47;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">US&#58; sin hallazgos de tromboembolia pulmonar &#40;10&#47;04&#47;20&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Paciente 6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Condensaciones alveolares progresivas&#44; colecci&#243;n pleural en hemit&#243;rax derecho &#40;hemot&#243;rax&#41; &#40;16&#47;05&#47;20&#41;Inserci&#243;n de drenajes tor&#225;cicos y toracotom&#237;a izquierda&nbsp;\t\t\t\t\t\t\n
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Información del artículo
ISSN: 00349356
Idioma original: Español
DOI:10.1016/j.redar.2021.03.009
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2024 Febrero 16 0 16
2024 Enero 19 0 19
2023 Diciembre 18 0 18
2023 Noviembre 12 0 12
2023 Octubre 10 0 10
2023 Septiembre 5 0 5
2023 Agosto 7 0 7
2023 Julio 4 0 4
2023 Junio 6 2 8
2023 Mayo 3 0 3
2023 Abril 2 0 2
2023 Marzo 1 0 1
2023 Enero 2 0 2
2022 Diciembre 3 0 3
2022 Noviembre 5 0 5
2022 Octubre 3 0 3
2022 Septiembre 6 0 6
2022 Agosto 5 0 5
2022 Julio 8 4 12
2022 Junio 2 2 4
2022 Mayo 4 0 4
2022 Abril 10 0 10
2022 Marzo 15 2 17
2022 Febrero 11 8 19
2022 Enero 96 22 118
2021 Diciembre 13 0 13
2021 Octubre 0 1 1
2021 Septiembre 0 2 2
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